| Broker | Address | Carrier | Commissions | Fees | Total comp | % of premium |
|---|---|---|---|---|---|---|
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL FL9 PHOENIX, AZ 85012 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $53K | $0 | $53K | 8.66% |
| PASSEY BOND CO INC3 | PO BOX 819 MESA, AZ 85211 | CIGNA HEALTH AND LIFE INSURANCE COMPANY | $51K | $0 | $51K | 8.23% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES | 3800 N CENTRAL AVE FL9 PHOENIX, AZ 85012 | COMPANION LIFE INSURANCE CO | $10K | $0 | $10K | 7.53% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | VISION SERVICE PLAN | $1K | $0 | $1K | 4.56% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $5K | $1K | $6K | 24.00% |
| HUB INTERNATIONAL MIDWEST LIMITED3 Filed as: BLACK GOULD & ASSOCIATES INC | 3800 N CENTRAL AVE FL 9 PHOENIX, AZ 85012 | UNUM LIFE INSURANCE COMPANY | $2K | $188 | $2K | 16.75% |
| PASSEY BOND CO INC3 | PO BOX 819 MESA, AZ 85211 | UNUM LIFE INSURANCE COMPANY OF AMERICA | $855 | $0 | $855 | 14.99% |
| Provider | Services | Address | Compensation |
|---|---|---|---|
| CIGNA HEALTH AND LIFE INSURANCE COM EIN 59-1031071 CLAIM ADMIN SERVICES AGMT | Non-monetary compensation; Claims processing; Contract Administrator; Named fiduciary; Float revenue; Participant communication; Other services; Direct payment from the plan Service code 12 | — | $561K |
Benefits declared on the Form 5500 main form (✓ = also has a Schedule A insurance contract; otherwise the benefit is funded out of plan assets or via a Schedule C TPA).
The plan reports several different headcounts depending on which form you read. Each one measures a different slice of the population.
| Active participants | 432 | Currently employed and enrolled or eligible. |
| Total participants (= "Plan participants" tile) | 432 | Active + retired/separated + beneficiaries. No dependents. |
| Coverage | Top carrier | Persons covered EOY | Premium |
|---|---|---|---|
| Dental | COMPANION LIFE INSURANCE CO | 425 | $127K |
| Vision | VISION SERVICE PLAN | 189 | $27K |
| Stop-loss / reinsurancereinsurance | CIGNA HEALTH AND LIFE INSURANCE COMPANY | 432 | $614K |
| Other(3 contracts, 2 carriers) | UNUM LIFE INSURANCE COMPANY OF AMERICA | 358 | $42K |
| Persons covered (= "Persons covered" tile) | Max across the rows above | 432 | — |
Why the numbers differ. Form 5500 line 6 counts employees + retirees + beneficiaries; no dependents. Schedule A persons-covered counts everyone enrolled, including spouses and children, so it usually exceeds line 6 by 30-60% on a working-age workforce. The medical row is normally the broadest single line because it has the highest take-up; dental/vision/life often dip below it. Stop-loss / reinsurance contracts sometimes report the carrier's full underwriting pool rather than this filer's headcount; the row is shown for transparency but shouldn't be read as "people in this plan."
Broker compensation exceeds 5% of premium. Either a small-plan minimum-fee dynamic or an inefficient broker structure ripe for a counter-bid.
Premium per covered life exceeds 2× the peer median for this NAICS + size cohort. Either richly-funded plan or struggling with a bad rate.